the following is a cnn special report. it's a disaster of biblical proportions. >> the moment that somebody codes and comes off the ventilator, it's clean. it's given to the next person. >> i fear that we will not have enough of anything to provide for our patients. >> what are you dealing with every day? >> people who can't breathe. it's as simple as that.

they can't breathe. >> we have been prepping for this our entire careers. we're either going to do this right now or die trying. >> we don't want to make the decision between two viable patients by simply trying to decide who is more worthy or flipping a coin. >> in our facility, we have 68 that have passed. >> the people i feel for are the families. especially the one this is never had an opportunity to say good-bye to their loved ones. >> i'm miguel marquez in brooklyn, new york. you're about to get a look at how intense the fight against coronavirus is inside the america's hospitals. we recently spent several hours inside a new york hospital experiencing the growing wave of

patients overwhelming the health care community. it is disturbing and sometimes deadly. almost impossible to imagine until you see it. it's not always size to after watch. this is "inside the e.r.: the incredible fight against coronavirus." the front line in the fight against coronavirus. the brooklyn emergency room of health sciences university. patient after patient, struggling to breathe. this morning has been brutal. >> today is pretty intense. we have had a bunch of people die in a short period of time. which we are prepared for, but when it happens so many times in one shift, it's hard to

tolerate. >> as we arrive inside the e.r., the latest victim is being wrapped up in the emergency room bay where doctors tried to save them. we visited for about three hours midday friday in the short time we were there in the emergency room alone, six patients coded. in other words, us they suffered heart or respiratory failure. four of them died. the devastating part of just one day. >> this is a what we trained to do and signed up for. just not in this volume. you may have a code. maybe on a bad shift, you may have two codes where you carry that emotion and you wonder if you did everything you could. i think it's emotionally hard to prepare for this level of sickness and suffering and morbidity and mortality in such a short period of time. i don't think any of us are well prepared for it. >> have you ever seen this e.r. jammed like this? >> not quite like these days, no. >> you're not at max yet, but you're pushing it. >> we're pushing it. at times the here there's no room to move. but we have a system of where we

decompress them out in the hallways. there are fast tracks. not many people here have taken in their children so e we have taken over pa taken over pediatrics. there's clinics we can turn into beds and they wait there once once they are stabilized and go upstairs. >> the corridors lined with those suffering from coronavirus. patients understand unresponsive, struggling to breathe. it's the hard reality of this virus for some patients it attacks the lungs depriving them of oxygen, slowly suffocating them. >> with covid, the pneumonia is not the just in one lung but rather in both lungs leaving the patient with no good lung. and it's also widespread throughout both lungs. it's damaging the lungs. >> keeping the most critically ill patients suffering from coronavirus breathing, it is as

simple as it gets in medicine. but still a mystery as coronavirus resists treatments. >> here in terms of the airway, we have to manage their airway once they become altered that they are unable to keep it open themselves. >> what's the mortality rate? once they are on a vent, what happens to mortality? >> it increases. >> more patients die? >> the numbers are not exactly the same from country to country. there are various factors for that. we all agree it skyrockets. >> there's fluid. >> an e.r. doctor who has done ground breaking work on putting more than one person on a single ventilators. it's research he hopes never has to be used here. >> what keeps us up at night is doing that kind of research. we want an alternative to give to these patients. not just for ventilators, but for cpap, oxygenation.

oxygen high flow. we try all sorts of maneuvers to keep them breathing and keep them from suffocating from having cardiac arrest. >> it's not just in the emergency room where patients struggle to breathe and code. while interviewing doctors in other parts of the hospital, nearly constant overhead announcements that another patient has coded. those announcements for patients already admitted, not those in the e.r. >> can i stop you for a second. this is the fifth or sixth code 99. >> code 99 is a typically a rare event. we're having i would say ten code 99s every 12 hours at least. >> we have been here for about 30 or 40 minutes and that's the fifth or sixth one. >> what that represents is calling for a team to put an individual patient on a

breathing machine. >> what is most jarring about seeing the inside of an er and hospital making the transition to being one of three in new york state that will only treat patients suffering from coronavirus, outside it is quiet and feels like an early spring day. >> it's slow moving. it's damn boring for a lot of people. but this is a disaster. >> this is definitely a disaster. it's difficult for people from the general public who don't work in hospitals. when you drive down new york avenue, which are pretty busy, it's almost crickets. but here in the emergency department it's an intensity you only see in disaster zones that have been televised around the world. >> it's a similar situation at brookdale hospitals a few miles. an emergency room inundated with patients suffering from

coronavirus. every hallway, every space filled with those suffering from the disease. the magnitude of the disaster captured in two emergency rooms rapidly filling to capacity. at suny, patient occupancy has gone up 50%. and the worst part hasn't even arrived. >> how quickly does a hospital get overwhelmed? >> within hours you could become overwhelmed. i'll give you an example. we had to open up two additional units to create beds for patients. we had to take up space and create a fourth icu to accommodate patients coming through the door. so it can change very quickly. >> it is ramping up adding beds, staff and capacity as fast as possible. still the worry, it won't be enough. >> i fear that we will not have enough of anything to provide for our patients. that's my biggest fear. we can mobilize staff, staff

will triple up, double up, by the support things like the respiratories and bed space, those are my fears that we are not going to be meet patient's needs. >> the need already overwhelming when we started our visit in the e.r., one person had just died and being moved out. by the time we came back around, another victim of coronavirus was moved already into the same bed, struggling to breathe. - my family and i did a fundraiser walk

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depend® fit-flex underwear offers your best comfort and protection guaranteed. because, perfect or not, life's better when you're in it. be there with depend®. doctors on the front line are confronting the mystery of the new coronavirus and the the disease it causes covid-19. it is part of a large family of viruss that have jumped from animals to people before. coronaviruses have caused everything from previous pandemic scares such as the sars and merz. they are also sometimes simply buzz of the common cold. while most case of this coronavirus see mild respiratory

illnesses, for some the virus invades the body threatening the life of the patient. it is those most extreme cases doctors here are seeing in ever greater numbers. >> is he an a vent now? >> he's on a ventilator. >> it's a disaster of biblical proportions. >> at suny down state, the barrage of emergency alarms. >> code 99, code 99. >> this is the fifth or sixth code 99. >> a constant and chilling reminder of the urgent need to figure out exactly how to treat coronavirus. >> code 99, patient 72. >> code 99 could mean someone that still has a pulse. the blood pressure but is struggling to breathe.

>> breathing, the number one concern. >> when somebody comes in here presenting with either covid symptoms or is positive for covid, how often is breathing the thing that might kill them? >> almost every time. we always have to do some kind of oxygenation on almost every covid patient that we keep in the hospital. >> at the end of the day, this is about people suffocating. >> this virus causes tremendous injury to the lungs. literally causing them to fill with fluid, which makes it difficult for your lungs to grab oxygen. >> a typical virus could be treated with antiviral drugs. so far, none very proven to be effective against coronavirus. >> imagine trying to treat severe bacterial pneumonia without antibiotics.

we're basically relying on a machine and the patient's own immune system to recover. that's not a position we want to be in. >> that's the same ventilator you can run two patients off of. >> absolutely. >> the machine is a ventilator, which pumps air in and out of their lungs. >> there's some fluid in the lungs. some patchy areas. >> so your suspicion that's a covid affected lung. >> yeah, this is one screen shot. as we finish looking at the lung, we find multiple areas of this on both sides, it increases our suspicion that he's suffering from covid. >> the numbers of hospitalized coronavirus cases show a sharp trajectory just over the last two weeks. the rate of shear infections nationwide even sharper.

johns hopkins university is tracking cases and so far only shows a sharp rise. >> this gentleman is suffering covid as well. >> yes. >> what exactly do we know about this virus? the answer still very little. >> we don't know that much a about it yet. even though it's been around for five months. we have been learning about it from other places where it started. every single day, we are reassessing our situations, what we have done prior day, prior month and try to make sense of it. this is unlike anything we have ever seen. 85% of the people stay out of the hospital. have flu-like symptoms, fever, cough and that's it. then you have this other 15% of the patient that comes to the hospital. because they are ill. 5% of those end up in the icu. intensive care unit. >> the possibility of a miracle cure like the anti-malaria drug

touted by the president -- >> it could be a game changer, and maybe not. maybe not, but i think it could be based on what i see, it could be a game changer. >> -- is still far from proven. >> we don't know if those things are working. we do get good responses sometimes. but i have to tell you honestly, the response have been disheartening at times. we're doing everything we can. our best we can. but we are not successful most of the times. >> it will work on some and not others. absolutely. >> suny down state's the infectious disease specialist says the various virus and how it acts still surprises him. >> we are looking into a pattern for the virus right now. how it acts on people when people get infected. but every time there's like some kind of new information comes up. if there's presentation, in terms of management, in terms of response to the supportive management or different medications. we still have some surprises about it.

the most common symptom we have right now is fever, shortness of breath and cough. not every patient has a fever. not every patient has shortness of breath. it is ranging, but the combination of those symptoms, those are the most common ones. >> does the assumption have to be that this virus is just everywhere? >> in the community. it is definitely in the community. or it's definitely in the community. that's why it's not just avoiding certain is kind of patients, but it should be going out of unless it's essential and necessary. >> the biggest unknown is how easily this virus can spread. >> can it spread through breath? somebody just breathing?

>> potentially, possibly. the more symptom the patient has, the more spread and risk for spreading will be higher for sure. but there are some cases where there are some instance where the patient is still no symptoms. and they start spreading the virus to other people. >> at this point, better to be safe than sorry. >> what i would say to people is to be prepared. my life was pretty normal three weeks ago. this happened almost overnight. and i think people have to have a high index of suspicion. if it you're seeing a lot of flu-like illness now today, you have to suspect it. even abnormal symptoms like abdominal pain, nausea, gi symptoms are frequently one of the manifestations of covid-19. and interestingly, that was not known early. in fact, in china there were

many a patients and doctors that got exposed because they weren't suspecting it. >> does it help you to have people tested rapidly and efficiently so you know what you're dealing with on this front? >> certainly, testing is helpful. people with symptoms are right now i would say you should assume you have it. here's the other thing. one of the things that delayed the rollout, this is a not a simple test that you can do in a doctors office. pcr takes some level of technical skill to do. the original test had up to 47% false negative rate. so that's bad. you're telling people you don't have it and you actually do. if your suspicion is high enough and the test is negative, go with your clinical suspicion.

>> is this the big one? >> it's definitely one of the biggest ones i have seen. i have been in practice for almost ten years now. and this is one of the most aggressive virus i have seen. in terms of the way it spreads, it's also in terms of mortality rates that we have been seeing compared to other viruses. >> health care workers here are ready for whatever coronavirus brings. >> we have been prepping for this for our entire careers. we're either going to do this right now or die trying. >> let's hope not the latter. i'm your mother in law.

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what are you dealing with every day? >> people who can't breathe. it's just as simple as that. they can't breathe. >> struggling to breathe. their lungs no longer able to deliver enough oxygen to keep their bodies going. this is the reality for the most extreme coronavirus patients. they need a ventilator to pump air in and out of their lungs. >> they are that sick. they are talking to you and then a few minutes later, you're put ing a tube down their throat and hoping that you can set the ventilator in such a way it actually helps them. >> she's a respiratory therapist at suny down state. she manages the ventilators that can help keep patients alive. >> it's not just this machine they talk about on tv that we don't have enough of. it's very complex. if you don't set it up right, that patient outcome is

different. you need skilled people who have lots of experience doing this to have good outcomes with these patients. these patients are so different from any patients we have ever seen before. we normally have a couple patients that are this level sick. our icus are filled with them. filled with them. none of them can breathe. >> are they unconscious the entire time they are on a ventilator? or can they be conscious? >> it's a bit of both. it depends on how critical the patient is. the more critical they are, the more we need to keep them sedated. these are basic push air in and out settings. these are aggressive and doesn't feel normal. so the patients are uncomfortable. they have all these tubes on them. if we lose an airway, we can lose them right then. >> doctors and therapists using ventilators on the front lines saying being hooked up to one doesn't mean you're in the

clear. >> if you're hooked up to a ventilator, it's as serious as it gets. >> yes, it's as serious as it gets. >> we talk about how more ventilators are needed. but if you go on a ventilator, that's not good news. >> no, it's not. you stay on the ventilator far long time. >> the average patient placed on the vent prior to this pandemic for this reason stayed on the vent for only three or four days. perhaps even a week. but with covid, they are staying on for 21 days, three weeks. so when they take up one of the vents, they also don't give it back to us any time soon. so that vent is taken out of circulation for an extraordinarily long time, longer than we're used to seeing. that contributes to the shortage. >> when it comes to the number of ventilators needed here in brooklyn and around the country, health care workers are fearing the the worst. >> we don't want to make the decision between two viable patients by simply trying to

decide who is more worth it. flipping a coin. we want to be able to offer a solution to everybody. >> for multiple patients to use one machine, one doctor who has done extensive research says the practice of splitting a single ventilator only works for some patients. sonchs rig>> so right here at s state, we did the experiment of co-ventilation where we ventilating four subjects we recommend two, but for proof of concept, we did four. we didn't want to try one with three. so if we did four, two would be easier and possible. you can use it with most ventilators as long as they have flow for the two subjects.gh air >> absolutely. by coincidence because it was done here, this is the exact model that we did the research on.

>> because it was down here, this is the exact model ventilator that we did the research on. >> some hospitals are already treating more than one patient the at a time on a single ventilator. this is a band-aid and not meant for long-term use. can you literally double the number of vents you have here? >> it's not as simple as that. it's not for every patient. some patients we're unable to put them on a vent because of other diseases that they have. it would proclude them for it. if you're having an active asthma attack, we couldn't share your vent because it would be too complicated. you need more parameters. it's not a solution to not having more vents. it was always meant to be a temporary bridge for hours, 12 hours, until an area hospital could deliver more vents or the stockpile can come. it's not for days or weeks. >> theoretically splitting means

every ventilator can help two people. >> splitting is not ideal by any stretch of the imagination. >> as we're moving toward the crest, what goes through your mind? >> every day we look at what the ventilator count is at. we have a robust disaster division here. so we have been preparing for a long time. my ventilator research dates back over a decade ago. it's the reason we were worried about sars, h1n1, anthrax, so we have been preparing for this for a long time. but i think my research might be more applicable to the smaller hospitals who don't have enough ventilators, don't have the preparation or the disaster committee or the budget for it. >> reporter: while they still haven't run out of ventilator the parts that had to be replaced every time a new patient is put on one, they are in short supply. >> the moment that somebody

codes and comes off the ventilator, it's clean, the tubing is changed and given to the next person. >> the machine is the same. but the tubing has to be changed out. the circuits, the filters. the filters and you can imagine ventilator use that we would do in a month we're doing in a day here. this is using up supplies at a rate that no one could have anticipated. >> i call vendors all day long. are my tubes coming. so i change ventilators, we're using alternate supplies every single day because this one can give me two cases today. that one two cases tomorrow. it's continual to keep the supplies coming in. we're helpless without them. >> despite the focus on ventilators, coronavirus patients that do need them still face an uphill battle. >> if you're on a ventilator, statistics show that the odds are against you. we're fighting for every single life. >> new york governor andrew cuomo warned that 80% of

patients on a ventilator in the state never recover. >> if you go on a ventilator, there's roughly only a 20% chance you will come off the ventilator. the longer you're on the ventilator, the lower the chance you come off. >> it is going to get worse. >> are you ready for it? >> i'm as ready as i can be. i have been preparing. you read about it. you don't think about it. you take one moment at a time. as the director of the department, i spend hours with logistics making sure that my staff have the tools that they need and that they have the supplies. they have ventilators, filters, our armor. we have it right now, but we know we can't take that for granted. >> you must be incredibly stressed. >> yeah, i'm incredibly stressed. but this is what we do. we'll be doing it every single day. my staff is here. we're ready for this fight.

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>> inside and out, suny state health sciences university

is dealing with a massive health crisis. at same time, it's transitioning to be a coronavirus only hospital designated as one of three in new york state. >> we're in high phase. we're turning areas of the hospital normally not used for patient care into patient care settings. >> the ambulance bay being transformed into a war zone triage area for victims of coronavirus. >> it has the feel of a field hospital. >> it does. we're really taking a lot of tactics from military medicine. disaster medicine is you make it up and improvise and get creative in times of disaster and epidemics. >> and you have how many beds now? >> we have about 220 staff members. we're going to plus up to over 350 at two locations. >> suny down state bay ridge a few miles away is aun used hospital. it's being called back into service. back at the main hospital, the tents outside will soon be the first place new patients are assessed.

>> in a week, two weeks, what will this look like? >> it will be jam packed. that's what we're ready for. >> reporter: the tents are state of the art. negative pressure chambers to keep the virus at bay and those working around it safe. a regular e.r. has a few negative pressure bays, but nothing like this. >> why does negative pressure help? >> if you don't have a negative pressure clinical care setting, the respiratory droplets in the air emitted from a covid patient would hang around. with negative pressure, it's vented out into the atmosphere where once it gets to the atmosphere it disintegrates. >> ppe, micro-resistant gowns, face shields and gloves still a constant struggle to keep supply. >> how much do you have? how long can you hold out? >> we're okay for today. we're not okay for next week. that's the frustration that many of us feel here in new york city and we only have six or seven

days supply in all of new york city. so my job is to think about next week. >> and ventilators and having enough for when the crest comes always a concern. >> how many do you have? how many do you need? >> we have about 65 today. we have about 30 patients on ventilators right now. so as you see, as the patients estimating that 25% of every patient we test will likely need icu care and/or ventilation. the youngest we have had is 3. the oldest is 95. >> all covid? >> all covid. >> wow, 3-year-old. >> good news is he went home. >> what was once the cafeteria will be transformed into a coronavirus ward. >> we're expecting a surge pretty soon. three to six weeks. that's what we're preparing for. between hospital which is staffed for 225, we're looking

to get another 50 to 60 beds in here. and then the at our bay ridge facility, 140 beds. >> to accommodate the new patients expected in new beds, it will take something in shortest supply. more staff. >> we're at 2,000 now. that's 205 beds. we need probably another 1,000 to 2,000 to come in. >> to almost double your staff? >> definitely. >> 12 volunteer doctors and nurses are already working. the another 30 or 40 want to. >> the group that is in my mind satisfying the most are the providers. the doctors, the nurses, the respiratory therapists. everybody donating their time. but donating their time is almost taking away from the bigger sacrifice they are making. they are putting themselves at risk, their families at risk to care for our patients. >> responsible for making sure there's enough of everything says medication to keep all those patients on ventilators >> what medications are you

sedated is in short supply. >> what medications are you running is short of? >> some pain medications like morphine. we're talking about sedatives. fentanyl, the medications that are required to keep patients on a ventilator sedated so that they don't fight the machine and get into more trouble they are already in. >> reporter: suny downstate is also ramping up testing. just this week it's able to conduct rapid tests in house. only a handful right now a day, but they would like to do 1,000 tests every day. >> right now, we have one instrument that we can do about 12 tests an hour. but we're quickly getting another instrument and actually a second flat form where we're going to be able to do many more than that. >> finding enough of these reagents needed to conduct every

single test, pushing staff in supplies to the limit. the hospital even expanding its capacity to care for the dead. >> right now, everyone is on a stretcher. no one is placed on the floor. we're doing it with most respect and dignity. >> the hospital's regular morgue already full. two refrigerated semitrailers now serve as a makeshift morgue, shelves will be added to increase capacity. and there's now a plan to close down a side street and move three more trailers into place.

triage? you have them in the system

then they come in. they sign the book. basically at capacity full. >> the doctor stressed here, it's pretty intense. >> already intense, stressful, but the coronavirus has yet to throw its most devastating punches at the resilient staff. of suny downstate. what you are dealing with is still not the crest of the wave? >> this is not the crest of the wave. we need to be ready mentally, physically. >> are you ready for what lies ahead? >> we feel prepared. >> are you ready? >> i feel prepared. part of the reason is because i have a team behind me. >> suny downstate isn't alone. brookdale hospital is being overwhelmed with patients suffering from coronavirus. unlike suny, doctors, nurses and staff when we visited didn't

have proper protective gear for dealing with a viral outbreak. >> we are doing the best we can. we are asking everybody to send prayers and support, but if you have donations, if you could send donations with gowns and gloves and masks and vents, we need it. >> look at the difference between suny down states now their staff in proper jump suits made to protect against microbes compared to what the staff at brook dale were wearing, paper emergency scrubs. and the emergency there every bit as intense. >>er quarter, every part of the hallway, every room, every space has been filled up to capacity with our patients and we're just doing the best we can. >> the numbers keep rising, and that's the part that scares me.

this is a war zone. it's a medical war zone. every day i come in, what i see on a daily basis is pain, despair, suffering, and health care disspareties. >> and the coronavirus battle has only just begun. >> do you expect it to get worse? >> yes, i do. >> get worse at brook dale. worse at sunni downstate and the rest of the united states. what people are seeing here will be in columbus and in chicago and in miami and in los angeles. this is the proverbial canary in a coal mine for what the rest of the country will see. >> yes. i did just did a talk. i trained a cook county hospital. they're getting ready for what we're experiencing right now. they believe they're two weeks

behind where we are right now. what happens in rural america in smaller community hospitals that have only a fraction of the vents we have but are being overrun with patients. in those patients just a few patients in some cases might overwhelm. >> you're worried? >> extremely. i've run into burning buildings, i've seen accidents. this scares me for myself and my family and for everyone else. >> michael magill cutie is also the supervisor and these trucks are his new temporary morgue, prepping for what they believe is ahead. >> i've been a funeral director for over 16 years. i worked with fema. this is pretty much the worst that i've seen because with a disaster we know what we're getting. here it's non-stop. >> how many body dos you guys have right now? >> in our facility right now we

have 68 that have passed. >> are either of these trailers full? >> no, they're not full at all. >> at sunni downstate, the work load overwhelming even doctors who see death every day but have never seen it like this. >> we are suffering psychological scars as is the community suffering psychological scars. it's tough on everyone. and the people i feel most for are the families, especially the ones that never have an opportunity to say good-bye to their loved ones. >> what you've seen is a small peak at what hospitals in new york city are dealing with right now. what's coming in the weeks ahead and a warning to the rest of the country. good night. ♪ ♪ i will hold

♪ i'll hold on to you >> i'm a new yorker. it's essential i'm here. ♪ >> it's a little risk coming outside, but kind of feel like a superhero saving the world. ♪ i'll reach my hands out in the darkness ♪ ♪ wait for yours to interlock ♪ oh, with you >> this is a war zone, it's a medical war zone. >> this is an extraordinary time where you need to see people at their best. ♪ i'm not giving up ♪ i'm not giving up, giving up ♪ no not yet ♪ even when i'm down to my last breath ♪ >> it is in our heart and in our soul to sacrifice, to serve, to fight for you. >> i'm not giving up ♪ ♪ i'm not giving up, giving up ♪ not me me ♪ even when nobody else believes ♪ ♪ i'm not going down that easily ♪ ♪ so don't give up on me

>> i travel coast to coast. as long as we can haul food for the american people, you will have plenty of food on those shelves. >> my heroes are all of the people that i work with who are showing up and helping us fight this pandemic. ♪ i will fight ♪ i will fight for you ♪ i always do ♪ until my heart is black and blue ♪ at papa john's, we want you to know that from our

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hello and welcome to our viewers here in the united states and all around the world. i'm michael holmes. now top medical experts are warning the u.s. brace yourself. this week's battle against coronavirus is going to be brutal. most of the country remains under stay-at-home orders with the number of cases rising well past 330,000. however, despite the seriousness of the situation, an upbeat u.s. president and vice president are suggesting the storm will soon pass. >> we see light at the end of the tun